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Thursday’s World Malaria Day arrived with some good news stories: the large-scale launch of a pioneering vaccine in Malawi is just one promising fresh approach to tackling the disease. Others include the introduction of better bednets, insecticides and diagnostics, new drugs to respond to the continuing threat of resistance and the potential through “gene-drive” technology to wipe out the mosquito that transmits the parasite between humans.
There has been some progress towards ending the disease among the 21 countries targeted for its elimination by next year. Yet the trend is less impressive in some of the highest burden countries such as Nigeria and there is backsliding elsewhere, notably in Venezuela, where government failures are undermining the health system and imposing a heavy human burden.
Much work still needs to be done to improve the data on malaria’s impact, notably to help countries focus their resources. But it is clear that global progress has stagnated, with around 200m annual cases and at least 430,000 deaths imposing a heavy human and financial toll.
There is limited potential or appetite for private sector funding mechanisms and in the build-up to “replenishment” fundraisings for international funding agencies this year, the monies invested remain far below the levels estimated to be necessary to tackle the disease.
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Abdourahmane Diallo, former health minister of Guinea and newly appointed chief executive of the Roll Back Malaria Partnership.
What is your interest in malaria?
I’m originally from Guinea and I couldn’t say how many times I’ve had malaria since I was a child. I’m a medical doctor by training and had an international public health career focused on developing countries. I worked for [US consultancy] JSI and the US President’s Malaria Initiative. I became minister of health in 2016 and when I finished I wanted to go back into public health and help tackle a disease with a global dimension.
What are your priorities at RBM?
We are at a critical phase in the fight against malaria. With the Global Fund to Fight Aids, TB and Malaria replenishment this year, we will step up the fight. My priority is to really call on all governments to play their part. To make the biggest difference, we need to help the highest malaria-burden countries get back on track through four key responses: political will, strategic data to drive impact, better guidance on up-to-date scientifically proven approaches, and a co-ordinated response.
What is the likelihood of ending malaria?
We believe it is possible to end malaria within our lifetime. But there has to be a global collective effort from all angles with all stakeholders to make it happen. Our theme is “malaria starts with me”. We are calling on pretty much everyone to contribute: political leaders to maintain their commitment to funding; the private sector; and the citizens of every country to play their part themselves, by teaching others and holding their political leaders accountable.
Budgeting for health New official data breaks down UK health spending by financing mechanism, function, and provider organisation. Government expenditure accounted for 79 per cent of the 2017 total, a proportion little changed since 2013. (ONS)
Vaccination fears grow World immunisation week celebrated vaccination successes but also noted the damage from misinformation in places like the Democratic Republic of Congo where the Ebola outbreak is spiralling.
New WHO and Unicef analysis said more than 20m children went unvaccinated each year over the past eight years, leaving 170m under-10s currently without protection. The top high-income countries where children did not receive a first vaccine dose are the US — which this week hit record levels of measles since it was eliminated in 2000 — followed by France, UK, Argentina and Italy. (VoA, Guardian, Washington Post, Unicef)
Antibiotics alert A biotech bankruptcy illustrated the disaster in the antibiotics market, said the Wellcome Trust chief: there is no viable route to market for new drugs, however valuable they may be to society. One possible route is switching to “pull” incentives which reward R&D done well. (FT, Wired)
Sexual health The US came under fire for having references to sexual and reproductive health removed from a UN resolution on sexual violence. British MPs hit out at anomalies in abortion rights in Northern Ireland. (BBC, UK parliament)
Frontline dilemmas Better guidance and training are needed for humanitarian workers in conflict zones faced with difficult ethical decisions. When a hospital is bombed, is it better to rebuild at the same location or move to a safer area but one which may make access for locals more difficult? (Johns Hopkins Center for Humanitarian Health)
Drugs by drone The world's largest drone delivery network is bringing medicines, vaccines and blood to 2,000 clinics in Ghana. Health workers will receive deliveries via a parachute drop within about 30 minutes of placing their orders by text message. (FT)
Food for thought The WHO called for industrially produced trans fats to be replaced by healthier fats and oils and eliminated from processed foods completely by 2023. Some UK campaigners highlighted the limited powers of local authorities to restrict advertising on unhealthy foods while others called for a new watchdog to tackle children’s food insecurity. The FT said meat needed to justify its presence on dining tables in the face of concerns over human health, animal welfare and the environment. (WHO, Guardian, Food Foundation, FT)
Indian health Healthcare is yet to become a major issue in the Indian general election despite serious problems such as out-of-pocket medical expenses causing great hardship. A dedicated LGBT clinic in Mumbai offers some respite from the discrimination experienced at many state facilities. (The Wire, Guardian)
Keeping active Some 23 per cent of adults and 80 per cent of adolescents are not sufficiently physically active and risk diseases such as obesity. The WHO's first guidelines for children's physical activity include recommendations on screen time. Some experts doubted the report’s evidence base. A separate study showed Americans becoming increasingly sedentary. (WHO, Guardian, Jama)
Millennial malaise A long-running US survey found millennials (those born between 1981 and 1996) were less healthy than their Generation X predecessors at the same age. The trend could have serious effects on the US economy over the next 20 years including on workplace productivity and healthcare costs. (Blue Cross Blue Shield)
Opioids crisis The US government filed the first criminal charges against a drug distributor for allegedly fuelling the country's opioid epidemic. President Trump vowed to continue the fight to the finish. (Reuters)
Big Pharma bets big As patents rise and shareholder pressure leads to cuts in R&D, Big Pharma has been buying smaller companies to fill their drug pipelines. Will the gamble be worth it? AstraZeneca boss Pascal Soriot reflects on Pfizer's attempted takeover of his company. (FT video, FT)
Dentistry doubts “We have a fraught relationship with dentists as authority figures,” argues a new analysis by The Atlantic. The profession lacks the same level of scientific scrutiny as medicine, it says, often leading to gratuitous procedures. Dentists are however ideally placed to help detect diabetes and cardiovascular disease. (The Atlantic, BMJ)
Truth or scare? A BBC series aims to separate medical truth from fiction. (BBC iPlayer)
Best from the journals
Investing in adolescent health More children and adolescents than ever before are exposed to risks of diseases from factors such as tobacco and alcohol use, processed foods and reduced physical activity. Early intervention could bring high returns on investment and reduce the risk of premature deaths. (BMJ)
Health emergencies Half the world's deaths come from medical emergencies, such as accidents, falls and burns (22 per cent); heart attacks (17 per cent); lung infections (11 per cent); and strokes (7 per cent), with a much higher incidence in poorer countries. Improvement could come through strengthening healthcare, transport, training and communication systems. (BMJ)
Medical misinformation Medical journals have an important role to play in galvanising and co-ordinating the response from the health community to medical misinformation. (Jama)
Transgender health The story of how one man built the largest study of transgender people in the world: The European Network for the Investigation of Gender Incongruence. (Nature)
A hidden disease Thousands of non-smokers die from lung cancer thanks to air pollution and other carcinogens but the condition is still viewed as a “smoker’s disease”. Screening for the condition has long been controversial. (Journal of the Royal Society of Medicine, The Economist)
Fantastic voyage Surgeons for a while have been able to steer robotic devices such as catheters but a new “self-driving” model uses artificial intelligence and image-processing to reach its destination. One analogy consists of fighter pilot and fighter plane: “The fighter plane takes on the routine tasks like flying the plane, so the pilot can focus on the higher-level tasks of the mission.” (Science Robotics)
Best meal of the day Missing breakfast could mean an increased risk of cardiovascular disease. (Journal of the American College of Cardiology)
Podcast of the week
Traveller health The traveller community suffers poor health outcomes because of problems accessing health and education services. How can GPs and hospitals support this neglected group? (BMJ, 28m)
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Greta Thunberg, the 16-year old climate change activist and Asperger’s sufferer, has taken the world by storm, but too many people with autism still face cruel treatment. (The Guardian)
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